VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer
187,133MODERNA
33,878JANSSEN
2,321PFIZER\BIONTECH
1,091GLAXOSMITHKLINE BIOLOGICALS
983UNKNOWN MANUFACTURER
363MERCK & CO. INC.
229SEQIRUS, INC.
45DYNAVAX TECHNOLOGIES CORPORATION
41NOVARTIS VACCINES AND DIAGNOSTICS
29SANOFI PASTEUR
18EMERGENT BIOSOLUTIONS
8PAXVAX
7TEVA PHARMACEUTICALS
4PFIZER\WYETH
3BERNA BIOTECH, LTD.
2SMITHKLINE BEECHAM
2INTERCELL AG
2PROTEIN SCIENCES CORPORATION
1CSL LIMITED

Incidents per State

State Total
77,548
AK1,869
AL5,581
AR3,688
AS47
AZ14,288
CA61,984
CO11,665
CT8,149
DC1,663
DE1,807
FL37,749
FM5
GA15,058
GU120
HI2,453
IA4,625
ID2,692
IL20,334
IN24,007
KS4,615
KY7,696
LA4,887
MA14,654
MD12,514
ME3,129
MH11
MI18,739
MN12,528
MO9,710
MP29
MS2,790
MT2,375
NC16,368
ND1,356
NE2,880
NH3,100
NJ17,634
NM3,916
NV4,239
NY34,355
OH19,081
OK6,195
OR8,636
PA23,083
PR2,370
QM2
RI2,088
SC6,411
SD1,212
TN9,131
TX35,174
UT4,273
VA14,937
VI64
VT1,676
WA14,909
WI11,259
WV2,388
WY861
XB5
XL1
XV2

ID: 0920654
Sex: F
Age: 48
State: TN

Vax Date: 01/02/2021
Onset Date: 01/02/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: bees, hornets, wasps cayenne pepper Aspirin (ASA) Penicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: After the initial dose of Benadryl wore off, my skin began to itch, as well as my throat and ears. My arm also swelled up to the size of a softball where the injection was. I developed some bumps on my body, but was not covered in a rash. I had no problems breathing. I was itchy all day Sunday and my arm seemed to go down a little, but on Monday, when I went to work and couldn't take the allergy meds, it swelled again to nearly the size of a baseball. I think I might be allergic to the acetic acid in it because that's part of the compound in Aspirin, but I'm not sure. It's Tuesday and I still feel yucky, my arm is still itchy and it's still feverish and swollen and red at the injection site. Please call me and let me know if I should take the second dose. My husband has heart failure and I am a teacher. I want to protect him, but I worry that I had that kind of reaction even after taking allergy medication just in case beforehand.

Other Meds: I took two Benadryl in case I had an allergic reaction because I have a history of allergic reactions to penicillin (a rash all over my body), bees ( anaphylaxis and swelling) and aspirin (huge hives and swelling of lips and tongue) before

Current Illness: None

ID: 0920655
Sex: F
Age: 23
State: IL

Vax Date: 12/30/2020
Onset Date: 01/01/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NA

Symptom List: Anxiety, Dyspnoea

Symptoms: I had awful migraines that did NOT improve with Tylenol or Ibprophen. My migraines had an aura to them on the 1/1/2021. I was also nauseous and had a difficult time keeping food down. I was also very tired and slept longer than I normally do. I had my vaccine done on 12/30/2020 and the symptoms did not occur until 1/01/2021. An hour or so after the injection, my arm started to become sore. It was very sore until 1/3/2021. They lasted until 1/3/2021. Now I feel fine.

Other Meds: A woman's probiotic and one a day vitamins

Current Illness: NA

ID: 0920656
Sex: F
Age: 0
State: MI

Vax Date: 03/11/2020
Onset Date: 03/11/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Chest discomfort, Dysphagia, Pain in extremity, Visual impairment

Symptoms: Patient received a Kinrex, however she was not 4 years old yet. Kinrex isn't licensed for under 4yrs old. Was found during a Site Audit on 01-04-2021.

Other Meds: None

Current Illness: None

ID: 0920657
Sex: F
Age: 47
State: MI

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: NONE

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: high heart rate, blotchy/flushed skin, urticaria

Other Meds:

Current Illness: NONE

ID: 0920658
Sex: F
Age: 44
State: TX

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: PERCOCET

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: dizziness and stated "feeling heart palpitations or PVC's" . stated she had a history of PVC's before and had an ablation in 2012.

Other Meds: MULTI VITAMINS METOPROLOL 25MG 1/2 TAB PO

Current Illness: N/A

ID: 0920659
Sex: M
Age: 52
State:

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chills, Confusional state, Eye inflammation, Headache, Laboratory test

Symptoms: About 24 hours after vaccination, patient reported fever, chills, and body aches.

Other Meds:

Current Illness:

ID: 0920660
Sex: M
Age: 1
State: NY

Vax Date: 12/29/2020
Onset Date: 12/31/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No Known allergies

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: The patient had already received his second influenza vaccine for the 2020-2021 influenza season (2 doses for his first immunization to the flu) and he accidently received a third influenza vaccine dose. The first dose was 9/20 and second dose was 1 month later 10/20 to complete the course. He received a third dose 12/30 accidently

Other Meds: Poly-Vi-Sol, Nasal saline solution

Current Illness: macrosomic baby

ID: 0920661
Sex: F
Age: 66
State: FL

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Moderna COVID - 19 Vaccine EUA

Other Meds: Synthroid .75 mg daily Ezetimibe 10 mg Vitamin C Vitamin D3 Folic Acid Vitamin B12 Fiber

Current Illness:

ID: 0920662
Sex: F
Age: 39
State: OH

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: lisinopril

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: later on the day in the evening i got my shot my arm turn redness around the site of the injection and iched still redness and ichy the next day local reaction redness ichy

Other Meds: none

Current Illness: none

ID: 0920663
Sex: M
Age: 70
State: FL

Vax Date: 01/03/2021
Onset Date: 01/03/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Swelling under nose and under the lower lip along with redness. Client released home after evaluation by onsite paramedic and physician at 3:43 pm.

Other Meds:

Current Illness:

ID: 0920664
Sex: F
Age: 29
State: IL

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: MKA

Symptom List: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Chills, Fever, Body ache, Headache, No appetite

Other Meds: Multivitamins

Current Illness:

ID: 0920666
Sex: F
Age: 21
State: IL

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Insomnia, fever, chills, tenderness in injection site

Other Meds:

Current Illness:

ID: 0920667
Sex: F
Age: 22
State: KS

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Shellfish, Oxycodone

Symptom List: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Fever, Body Aches, Headache, chills and nausea started at 10pm on 1/4/2021. Patient was seen in office on 1/5/2020. Patient was sent home to rest and advised to take tylenol

Other Meds: Certirizine, Fluticasone, Zofran

Current Illness: Sneezing, itchy throat and congestion in December

ID: 0920668
Sex: F
Age: 51
State: CA

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dyspnoea, Fatigue, Feeling abnormal, Head discomfort, Headache

Symptoms: Itchy Red Mark around the injection site tender to the touch

Other Meds:

Current Illness:

ID: 0920669
Sex: F
Age: 40
State: IL

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Headache, Chills, Body Ache, Nasal congestion, Swollen injection site

Other Meds: Albuterol

Current Illness: None

ID: 0920670
Sex: F
Age: 26
State: FL

Vax Date: 12/28/2020
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Site pain and swelling for 6 days after vaccination. Day 7 post vaccination; redness, itching, edema at injection site, circular area, about 5 inches in diameter. Plus swollen, painful axillary lymph nodes bilaterally.

Other Meds:

Current Illness:

ID: 0920671
Sex: F
Age: 62
State: AZ

Vax Date: 12/23/2020
Onset Date: 01/05/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: None

Symptom List: SARS-CoV-2 antibody test, SARS-CoV-2 test negative

Symptoms: Left arm itchy and red.

Other Meds: Insulin, Blood pressure . Colestrol, vitamin 12, Sun Chlorella

Current Illness: None

ID: 0920672
Sex: F
Age: 60
State: TX

Vax Date: 12/17/2020
Onset Date: 12/17/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: UNK

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Employee received the vaccine around 1130. She was monitored for a least 30 minutes due to her history of CA and Immunosupressed state. She went back to her office post monitoring. Around 1535, one of her employees called reporting that she didn't look good and was acting weird - pale; stumbling; slurred speech. The coworker brought employee to the immunization clinic in private vehicle. Dr. along with the CNE and another RN went to the vehicle to asses. It was noted that employee did have slurred/slow speech; droopiness to face. She reported that she started to not feel well while in her office. V/S: B/P 141/102; pulse 108; O2 sat 96% on RA; skin pale. She stated that she felt "loopy". Employees husband was called and her co-worker was instructed to take the employee to the ER where her husband would meet them. At 1540, employee was taken to ER for evaluation.

Other Meds: UNK

Current Illness: UNK

ID: 0920673
Sex: F
Age: 37
State: GA

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I received the Moderna COVID vaccine on 12/29. 12 hours after the vaccine I had numbness and tingling in my feet. The following morning (24 hours post vaccine) I still was having numbness and tingling in my feet and my legs from knees down felt weak and jelly like. I still was able to walk fine, but it was uncomfortable, not able to work out etc. 12/31 (48 hours post) I worked for 10 hours this day and symptoms were the same, that evening I continued to have same symptoms and my knees and ankles ached intermittently. 1/1- Same symptoms as previous days. 1/2- Same symptoms and started having tingling down back of upper leg from butt to back of knee, still tingling in feet. 1/2- Went to ER waited 8 hours and left. 1/3- Went to ER and they ruled out Guillain Barre Syndrome (did complete neuro exam) and said they have not seen this particular reaction to the vaccine but due to presentation they believe it is a vaccine reaction. No treatment prescribed.

Other Meds:

Current Illness: None

ID: 0920674
Sex: M
Age: 27
State: FL

Vax Date: 12/29/2020
Onset Date: 01/01/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data:

Allergies: None

Symptom List: Blood pressure increased, Chest discomfort, Heart rate increased

Symptoms: Swollen lymph node under left armpit for four days starting 01.01.2021.

Other Meds: None

Current Illness: None

ID: 0920675
Sex: F
Age: 40
State: NY

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Lymph node pain, Lymphadenopathy

Symptoms: Fever, body aches, chills and sweats

Other Meds: N/A

Current Illness: cough

ID: 0920676
Sex: F
Age: 46
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Unevaluable event

Symptoms: Tachycardia started after 12 minutes, observed for 45 minutes. Symptom resolved over this period of time

Other Meds: None

Current Illness: None

ID: 0920677
Sex: M
Age: 38
State: MA

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Patient experienced minor burning on administration to Left Deltoid. Moderna COVID vaccine

Other Meds:

Current Illness:

ID: 0920678
Sex: F
Age: 28
State: AZ

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No known allergies to date

Symptom List: Injection site pain, Pain

Symptoms: Injection area mid upper arm. Edema to injection area , discoloration, 2 inch circular demarcation, pain to local area, itchiness numbness and tingling to left hand during first 7 days. Day 8 hard mass at injection site, rash, discoloration still present. Itchiness still present. PO benadryl taken, topical benadryl applied when PO not taken. Minimal relief from benadryl.

Other Meds: Topamax, Fluxotine,

Current Illness: No illness prior to or on vaccination date

ID: 0920679
Sex: F
Age: 41
State: NY

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: No Known Allergies

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient reported having a swollen epiglottis on the date of the vaccination that did not resolve until the following date.

Other Meds:

Current Illness:

ID: 0920680
Sex: F
Age: 39
State: IL

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Arthralgia, Chills, Headache, Mobility decreased, Myalgia

Symptoms: I took the "Moderna COVID-19 Vaccine EUA" on December 31, 2020. I had pain/soreness at the injection site for 3 days, but I still have other side effects since getting the vaccine. The side effects started out with mild muscle pain and joint pain on the 31st, then in the night and for every day since the vaccine I have had headaches which I am taking ibuprofen for. I also feel quite fatigued since getting the injection. In the last few days I also had cold sweats, and chills yesterday. Today, I still have headache and fatigue.

Other Meds: Ibuprofen

Current Illness: None

ID: 0920681
Sex: F
Age: 46
State: RI

Vax Date: 12/28/2020
Onset Date: 12/30/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Sulfa, Augmentin, Keflex

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Modern a COVID-19 Vaccine EUA I was given the injection last Monday and noted erythema itchiness and swelling to the site and I figured I?d keep an eye on it. Also I had been enrolled in the v-safe with the CDC so I felt if there was ever a red flag, that they would be aware. After about 2 days it seemed better but then on 1/4/2021 I noticed it was itchy again and I saw that I had a couple of blisters but they did go away after a hour. I now have the erythema, itchiness and a very hard (bigger than a half dollar) area surrounding the injection site. Today is day two of having this and no swelling noted in my axilla or lymph nodes. No fever.

Other Meds: Vitamin D, Tumeric, Magnesium, Prozac, prn Motrin & Tylenol

Current Illness: None

ID: 0920682
Sex: F
Age: 47
State: TX

Vax Date: 01/03/2021
Onset Date: 01/03/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Recently noticed allergic to IV or intramuscular shots that leads to irregular heartbeat, low blood pressure

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: With in 2 minutes of shot felt: 1. Medicine being diffused out of heart with burning sensation that lasted about 30sec that followed by 2. Irregular heartbeat (that lasted about 5 minutes) 3.Need to get fresh air (felt like lowering mask) 4. Low blood pressure that caused little sweaty and cold hands All the symptoms in total lasted for 5 minutes and then I felt back to normal

Other Meds: None

Current Illness: None

ID: 0920683
Sex: F
Age: 54
State: MI

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: PCN

Symptom List: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Started to feel dizzy about 9 hours after the injection. Went to bed. Woke up 8 hours later with an extreme headache 9/10 and nausea. Took 325 Tylenol and brought the pain down to a 7/10. Slept for a couple of hours and woke up with a headache at a 7/10 - took 650 mg Tyleno, drank some Focus Aid and ate some veggie straws. After about 1/2 hour the headache was down to a 4/10,

Other Meds: Multivitamin, Vitamin D

Current Illness: none

ID: 0920684
Sex: M
Age: 53
State: GA

Vax Date: 12/21/2020
Onset Date: 12/30/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NONE

Symptom List: Nausea

Symptoms: NONE

Other Meds: AZITHROMYCIN 250MG TABLET DEXAMETHASONE 4 MG TABLET FAMOTIDINE 40 MG TABLET METROPRLOL SUCC Er 100 MG TABLET MONTELUKAST SOD 10 MG TABLET PANTOPROZOLE SOD DR 40 MG TABLET ROSUVASTATIN CALCIUM 20 MG TAB VITAMIN D2 1.25MG

Current Illness: NONE

ID: 0920685
Sex: M
Age: 51
State: NY

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

Symptom List: Injection site pain

Symptoms: Fever 100.2, chills, headache and body ache.

Other Meds: Rosuvastatin (Crestor) Amlodopine Besylate

Current Illness: None

ID: 0920686
Sex: F
Age: 40
State: NY

Vax Date: 12/27/2020
Onset Date: 01/04/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Bactrim

Symptom List: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Patient states - she initially had headache, L arm swelling and pain and it went away by day 5. Then the site swelled again and is now red, itching and has minor pain.

Other Meds: Selenium Famotidine Combivent Multivitamin Vitamin C Vitamin B12

Current Illness: None

ID: 0920687
Sex: F
Age: 43
State: WI

Vax Date: 12/28/2020
Onset Date: 01/05/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: no

Symptom List: Chills, Dizziness, Nausea, Pain, Tachycardia

Symptoms: localized erythema, warmth, swelling at injection location. itchy. tender to palpation

Other Meds: turmeric and curcumin ashwaganda green tea extract vitamin D trazodone hydroxyzine

Current Illness: no

ID: 0920688
Sex: F
Age: 53
State: VA

Vax Date: 01/03/2021
Onset Date: 01/03/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Erythromycin Iodine Shell fish/fish Morphine Augmentin Strawberries

Symptom List: Tremor

Symptoms: Tingling lips Sore throat Burning in chest Rash Headache Neck stiffness SOB

Other Meds: Benadryl Ibuprofen Vitamin D Melatonin

Current Illness: None

ID: 0920689
Sex: M
Age: 43
State: OK

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: wasp venom

Symptom List: Erythema, Pruritus

Symptoms: Client started c/o headache, tightness in chest, and was anxious. He was helped out of his truck and taken to triage where they administer o2 4Liters via nasal cannula. He self administered his albuterol inhaler. He admits to having anxiety issues. He was monitored for 20 mins and no other problems arose and he felt better after that. He has had no other problems related to the vaccine since that occasion. He did not contact his doctor.

Other Meds: generic Zoloft, trazadone, albuterol inhaler

Current Illness: bronchitis and asthma problems one month prior to vaccine

ID: 0920690
Sex: F
Age: 30
State: PA

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

Symptom List: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling, Myalgia

Symptoms: Severe Headache; Light sensitivity; Nausea; Bilateral upper extremity tingling

Other Meds:

Current Illness:

ID: 0920691
Sex: F
Age: 36
State: CA

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Fever Body aches

Other Meds:

Current Illness:

ID: 0920692
Sex: F
Age: 59
State: IL

Vax Date: 12/24/2020
Onset Date: 12/24/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Zithromax and Diflucan

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Chills, head ache, Body ache, fever, leg pain

Other Meds: Tylenol

Current Illness: Patient was sick in November with fever, chills and fatigue. Testx2 for COVID negative both times.

ID: 0920693
Sex: M
Age: 40
State: IA

Vax Date: 12/31/2020
Onset Date: 01/01/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Sulfa, environmental allergies

Symptom List: Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Arm soreness for 3 days following injection Fatigue day after injection Sore throat, feels like swollen tonsils began 2 days after injection and continues today Visible sore under tongue began 2 days after injection and continues today

Other Meds: Lisinopril, Flonase, Zyrtec, multi-vitamin

Current Illness: Sinus infection prior

ID: 0920694
Sex: F
Age: 43
State: TX

Vax Date: 12/28/2020
Onset Date: 12/30/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Chills, Feeling cold, Feeling hot, Myalgia, Pain

Symptoms: I had lymphadenopathy in my right armpit for three days post vaccine. I used a heating pad to treat. I also developed swelling on my right forearm that was hot to touch with pain. I used a heating pad as well on my right forearm and took Tylenol for two days-it resolved.

Other Meds: Flonase; Symbicort

Current Illness: None

ID: 0920695
Sex: F
Age: 53
State: CO

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: n/a

Symptom List: Pain in extremity

Symptoms: headache, low grade fever, body aches, nausea

Other Meds: mobic, levothyroxine

Current Illness: n/a

ID: 0920696
Sex: F
Age: 50
State: NY

Vax Date: 12/28/2020
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: Ibuprofen macrobid apples pineapple

Symptom List: Abdominal pain upper, Abnormal behaviour, Adverse reaction, Anger, Asthma

Symptoms: 9cm by 9cm area left deltoid; raised, hot to touch, pruritic topical steroids mupirocin to minor excoriations from itching zyrtec 10 mg qd benadryl prn cool compresses

Other Meds: Proventil Hfa/ Marlissa 0.15-30 mg-mcg oral tablet/ Flonase/ zyrtec allergy 10 mg oral tablets/ Flovent hfa 44mcg/ Estrace 0.1mg/ gm/ vaginalcream/ buproion xl 300mg tabs/ mupirocin/ hydrocrtisone 2.5 %/ protopic 0.1% external ointment/

Current Illness: None known

ID: 0920697
Sex: F
Age: 64
State: IL

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NONE

Symptom List: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: FEVER

Other Meds: NONE

Current Illness: NONE

ID: 0920698
Sex: F
Age: 50
State: ME

Vax Date: 12/21/2020
Onset Date: 12/23/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Erythromycin

Symptom List: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Burning/ tingling tongue

Other Meds: No

Current Illness: No

ID: 0920699
Sex: M
Age: 57
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Vomiting

Symptoms: Joint Pain, Arm Pain near injection site, chills, not taking anything for pain, but will take acetominophen tonight so I can sleep

Other Meds: None

Current Illness: None

ID: 0920700
Sex: F
Age: 29
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient felt pain and heaviness to right back side of head/neck area and reported dizziness. Patient states she has a history of vertigo and gets dizzy easily.

Other Meds: unknown

Current Illness: unknown

ID: 0920701
Sex: F
Age: 27
State: IL

Vax Date: 12/17/2020
Onset Date: 12/18/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: 12/18/20- reports suddenly got sweaty, hands felt cold, then got nauseous. Reports vomitted x 1. Reports the rest of the day felt tachycardiac for a few hours (HR 120-140) and dizzy. Started getting muscle aches/joint aches. Denies any recent COVID exposure. Tested positive for COVID In 8/2020. Reports hips/knees are throbbing today; Heart rate WNL. /// Presenting today due to intermittent presyncope and palpitations. Also notes generalized weakness. Patient evaluate 2 L of fluid given her Mirena IUD D-dimer was sent which was negative patient with no pleuritic symptoms or dyspnea to suggest pulmonary embolism. Otherwise hemodynamically stable on exam ambulates with no difficulty no focal neurologic deficits. Patient did describe on her initial presentation that she noted some weakness of her bilateral legs. Given her possible viral reaction and description of weakness it is possible the patient is developing an early autoimmune reaction however she has no evidence of GuillainBarr? or transverse myelitis on my exam. We will plan to discharge with neurology follow-up as outpatient.

Other Meds:

Current Illness:

ID: 0920702
Sex: F
Age: 38
State: IL

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Fever, chills, Headache, Body Malaise

Other Meds: none

Current Illness:

ID: 0920703
Sex: M
Age: 69
State: TX

Vax Date: 01/03/2021
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Penicillin drugs

Symptom List: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Mild pain at injection site increased to moderate/moderately severe requiring two doses of acetaminophen 825 mg p.o. Pain reached a maximum at around 9 pm on 1/4/21. Malaise, body aches, skin sensitivity also increased during the day on 1/4, relieved somewhat by the Tylenol. I was never able to document fever though I felt "feverish". Awoke on 1/5/21 feeling better and all symptoms are steadily improving though not completely resolved at time of this report, 1045 hours on 1/5/21.

Other Meds: Sotalol 80 mg bid Eliquis 5 mg bid Allopurinol 100 mg q day Simvastatin 20 mg q evening at bedtime Culturelle 1 capsule each day Multivitamin Centrum Silver

Current Illness: None

ID: 0920704
Sex: F
Age: 45
State: PA

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Hot flush, Myalgia, Nausea, Tension headache

Symptoms: Moderna COVID-19 Vaccine EUA 7 small itchy marks/ bumps on left wrist progressively worsening to swelling, warmth surrounding left wrist (day 6). 2 red marks above left clavicle and 1 red mark on right eyelid (day 5).

Other Meds: none

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm